Child and Adolescent Psychiatry Practice Questions

Q: A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?

Selective mutism. ***Selective mutism*** - This condition is characterized by a **consistent failure to speak in specific social situations** (e.g., school) despite speaking in other situations (e.g., at home with close family). - The child's **appropriate participation in class activities** and use of alternative communication methods (gestures, drawings) are typical features. *Autism* - Children with autism spectrum disorder often exhibit **deficits in social-emotional reciprocity** and may have **restricted, repetitive patterns of behavior or interests**. - While they may have communication challenges, the selective nature of the mutism and otherwise appropriate social engagement in the classroom argue against autism. *Expressive language disorder* - This disorder involves difficulty **producing spoken language**, regardless of the setting. - The fact that the child speaks normally at home suggests her expressive language abilities are intact, making this diagnosis unlikely. *School phobia* - School phobia, now often referred to as **school refusal**, is characterized by symptoms of anxiety or panic when attending or anticipating school. - While the child might be anxious, her ability to participate in class activities and communicate nonverbally suggests the primary issue is not an avoidance of school itself but a selective inability to speak.

Q: Most common type of intellectual disability –

Mild. ***Mild*** - **Mild intellectual disability** is the most prevalent type, accounting for approximately **85%** of all cases. - Individuals with mild intellectual disability can often achieve academic skills up to a **sixth-grade level** and live relatively independently with appropriate support. *Severe* - **Severe intellectual disability** is less common, affecting about **3-4%** of individuals with intellectual disability. - These individuals typically require **daily supervision** and support in structured environments. *Profound* - **Profound intellectual disability** is the least common type, affecting only **1-2%** of individuals with intellectual disability. - Individuals with profound intellectual disability require **intensive support** for all aspects of daily living and often have significant physical impairments. *Moderate* - **Moderate intellectual disability** accounts for about **10%** of all cases. - Individuals with moderate intellectual disability can often develop communication skills and manage basic self-care, but require **ongoing supervision** and support.

Q: All are true about Tourette syndrome, EXCEPT :

More common in females. ***More common in females*** - **Tourette syndrome** is significantly **more common in males** than in females, with a male-to-female ratio of approximately 3-4:1. - The prevalence and severity of tics are generally higher in males. *Motor tics* - **Motor tics** are a **defining characteristic** of Tourette syndrome, encompassing a wide range of movements such as blinking, head jerking, or shoulder shrugging. - For a diagnosis of Tourette syndrome, both **multiple motor tics** and at least one vocal tic must be present. *Associated with OCD* - **Obsessive-compulsive disorder (OCD)** is a **frequently co-occurring condition** in individuals with Tourette syndrome, often more impairing than the tics themselves. - The association is thought to stem from shared underlying neurobiological mechanisms involving the **basal ganglia** and **cortico-striato-thalamo-cortical circuits**. *Neuroleptics are used in the treatment* - **Neuroleptics**, particularly **dopamine receptor blockers** (e.g., haloperidol, risperidone, aripiprazole), are often used to reduce the severity and frequency of tics in Tourette syndrome. - These medications help by modulating **dopaminergic activity** in the brain, which is implicated in tic generation.

Q: Attention deficit hyperactivity disorder is characterized by-

All of the options. ***All of the options*** - **Attention deficit hyperactivity disorder (ADHD)** is characterized by a persistent pattern of **inattention and/or hyperactivity-impulsivity** that interferes with functioning or development. - All three features—**impulsivity**, **inattention (poor attention)**, and **hyperactivity**—represent the core symptom domains of ADHD according to **DSM-5** criteria. - ADHD presentations can vary: **predominantly inattentive**, **predominantly hyperactive-impulsive**, or **combined presentation** (most common). **The Three Core Features:** **Impulsivity** - Acting without thinking or considering consequences - Difficulty waiting turns or delaying gratification - Interrupting or intruding on others - Making hasty decisions without forethought **Inattention (Poor Attention)** - Difficulty sustaining attention in tasks or play - Easily distracted by extraneous stimuli - Forgetfulness in daily activities - Poor organization and time management - Frequently loses things necessary for tasks **Hyperactivity** - Excessive motor activity and restlessness - Fidgeting, squirming, or inability to remain seated - Running or climbing inappropriately (in children) - Feeling internally restless (in adults) - Talking excessively *Why individual options alone are incomplete:* While each symptom domain can be prominent in different ADHD presentations, the disorder is comprehensively **characterized by all three core symptom clusters**, making "All of the options" the most accurate and complete answer.

Q: In a child with IQ 50, which of the following is true:

Can follow simple verbal commands. ***Can follow simple verbal commands*** - An IQ of 50 typically falls into the **moderate intellectual disability** range (IQ 35-50), where individuals can understand and follow **simple instructions** and commands. - This level often allows for some degree of **communication and basic learning** with appropriate support and training. *Can look after himself independently* - While individuals with an IQ of 50 may achieve some level of independence with training, **full self-care** in complex situations typically requires ongoing support or supervision. - They may struggle with **complex problem-solving** or managing all aspects of independent living without guidance. *Can handle money* - Handling money, including budgeting, making change, or understanding financial transactions, is a **complex skill** that is often challenging for individuals with an IQ of 50 without significant training and support. - They may understand the basic concept of money but struggle with its practical application in varied scenarios. *All of the options* - While simple verbal commands are usually manageable, the other options (full independent self-care and complex money handling) are typically beyond the general capabilities of an individual with an IQ of 50 without substantial support or specific, intensive training. - Therefore, not all listed options accurately describe the expected functional abilities.

Q: Coprolalia is seen in:

Tourette's syndrome. ***Tourette's syndrome*** - **Coprolalia**, the involuntary utterance of obscene words, occurs in only **10-15%** of individuals with Tourette's syndrome, despite being commonly portrayed in popular media as a defining feature. - Tourette's syndrome is primarily characterized by **motor and vocal tics**, with coprolalia being just one possible but **uncommon vocal tic manifestation**. *Delirium* - Delirium is characterized by an **acute disturbance in attention and awareness**, often fluctuating, and is not typically associated with coprolalia. - Common symptoms include **disorientation**, perceptual disturbances like hallucinations, and agitation, but not specific vocal tics. *Alcoholic intoxication* - While alcohol intoxication can lead to disinhibition and impaired judgement, it does not specifically cause involuntary verbal tics like **coprolalia**. - Symptoms usually include **slurred speech**, ataxia, and altered mood or behavior. *Mania* - Mania is characterized by an **elevated or irritable mood**, increased energy, and goal-directed activity, sometimes with pressured speech and racing thoughts. - While speech can be rapid and expansive, it does not usually involve involuntary obscene utterances like **coprolalia**.

Q: The hyperkinetic disorder is characterised by all, except-

Hallucinations. ***Hallucinations*** - **Hallucinations** are perceptual disturbances and are not a defining characteristic of hyperkinetic disorders (also known as Attention-Deficit/Hyperactivity Disorder or ADHD). - While other psychiatric conditions can co-occur with ADHD, **hallucinations** themselves indicate a different primary diagnosis or a more complex clinical picture. *Distractibility* - **Distractibility** is a core symptom of hyperkinetic disorders, reflecting an inability to maintain focus on a single task or stimulus. - This symptom contributes significantly to impaired academic, occupational, and social functioning. *Impulsivity* - **Impulsivity** is a key feature of hyperkinetic disorders, characterized by acting without forethought or consideration of consequences. - This can manifest as blurting out answers, interrupting others, or engaging in risky behaviors. *Hyperactivity* - **Hyperactivity** is a hallmark symptom, involving excessive motor activity that is often out of proportion to the situation. - This can include fidgeting, squirming, difficulty remaining seated, and excessive talking.

Q: Microcephaly is seen in

Rett's disease. ***Rett's disease*** - **Microcephaly** is a characteristic feature of Rett's disease, typically developing between 6 months and 4 years of age as brain growth decelerates. - This neurodevelopmental disorder primarily affects girls and is caused by mutations in the **MECP2 gene**, leading to severe intellectual disability, communication problems, and loss of purposeful hand use. *Asperger's syndrome* - Individuals with Asperger's syndrome typically have **average or above-average intelligence** and normal head circumference. - It is characterized by difficulties in social interaction and nonverbal communication, with restricted and repetitive patterns of behavior and interests, but not microcephaly. *Heller's disease* - Also known as Childhood Disintegrative Disorder, Heller's disease is a rare condition where a child develops normally for at least two years before suffering a **severe regression** in multiple areas of development. - It does not specifically cause microcephaly; rather, it involves a loss of previously acquired skills in language, social function, and motor skills. *Autistic disorder* - While some studies have shown an increased head circumference (macrocephaly) in a subset of individuals with autism, **microcephaly is not a typical finding** in autistic disorder. - Autistic disorder is characterized by persistent deficits in social communication and social interaction, and restricted, repetitive patterns of behavior, interests, or activities.

Question 1

A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?

Accepted Answer

Selective mutism

Answer

Autism

Answer

Expressive language disorder

Answer

School phobia

Question 2

A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from

Accepted Answer

Specific learning disability

Answer

Examination anxiety

Answer

Lack of interest in studies

Answer

Intellectual disability

Question 3

Most common type of intellectual disability –

Accepted Answer

Mild

Answer

Severe

Answer

Profound

Answer

Moderate

Question 4

All are true about Tourette syndrome, EXCEPT :

Accepted Answer

More common in females

Answer

Motor tics

Answer

Associated with OCD

Answer

Neuroleptics are used in the treatment

Question 5

Attention deficit hyperactivity disorder is characterized by-

Accepted Answer

All of the options

Answer

Impulsivity

Answer

Poor attention

Answer

Hyperactivity

Question 6

In a child with IQ 50, which of the following is true:

Accepted Answer

Can follow simple verbal commands

Answer

Can look after himself independently

Answer

Can handle money

Answer

All of the options

Question 7

Coprolalia is seen in:

Accepted Answer

Tourette's syndrome

Answer

Delirium

Answer

Alcoholic intoxication

Answer

Mania

Question 8

The hyperkinetic disorder is characterised by all, except-

Accepted Answer

Hallucinations

Answer

Distractibility

Answer

Impulsivity

Answer

Hyperactivity

Question 9

A 10-year-old child has been restless, unable to sit still in class, frequently interrupting others, and unable to complete homework for the past 8 months. Teachers report similar inattentive and hyperactive behaviors at school. Academic performance has declined significantly. The parents are extremely distressed. What would you advise as the initial management?

Accepted Answer

Behaviour therapy

Answer

It is a normal behaviour

Answer

Needs change in environment

Answer

It is a serious illness that requires medical treatment

Question 10

Microcephaly is seen in

Accepted Answer

Rett's disease

Answer

Asperger's syndrome

Answer

Heller's disease

Answer

Autistic disorder

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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